Thoughts about DSM-5

JUST recently, my friend, Ms. Erlinda “Dang” Koe, who is the Chairman Emeritus of Autism Society Philippines and also a writer for a national newspaper, sent me and some parents and professionals, a link on the DSM-5 and asked about our comments on it.

The DSM, which stands for Diagnostic and Statistical Manual of Mental Disorders, provides a common language and standard criteria for the classification of mental health conditions. It was first published in 1952 by the American Psychiatric Association (APA) when the US armed forces wanted a guide on the diagnosis of servicemen. The DSM is periodically updated since mental health is evolving. In each revision, mental health conditions that are no longer considered valid are removed, while newly defined conditions are added.

After more than a decade (about 14 years) of reviewing the criteria, the APA released the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) this May. The DSM-5 is like a bible for professionals as it provides a definitive list of all recognized mental health conditions, including their symptoms. It is widely used by doctors, psychiatrists, pharmaceutical companies, teachers, and therapists because of its major influence on how mental health is thought about and is treated in almost all countries.

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There are many changes introduced by the DSM-5 as compared to the previous DSM-4. For example, intellectual disability has become the new term for mental retardation or that “phonological disorder and stuttering are now called communication disorders -- which include language disorder, speech sound disorder, childhood-onset fluency disorder," or that “a new condition characterized by impaired social verbal and nonverbal communication is now called social (pragmatic) communication disorder."

What are the major changes related to autism spectrum disorder? The DSM-5 reduced the symptoms of ASD from three categories in DSM-4 (impairments in social interaction, communication and repetitive or stereotypic behaviors) to just two categories: social communication and interaction, and restricted and repetitive behavior. Under the new manual, children can now be classified as Level 1 "Requiring support”; Level 2 "Requiring substantial support” and Level 3 "Requiring very substantial support." Another major change is that the diagnosis of Asperger’s syndrome, Autism and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) are now classified into just one category: Autism Spectrum Disorder.

This is what I shared with Ms. Koe: “When my eldest son was diagnosed at the age of three, I asked the developmental pediatrician about the severity of his autism. The doctor said she prefers not to specify what level he was in. In a way, her response spared me from additional stress apart from the devastating impact of hearing the diagnosis of my son. But at the same time, I also badly needed information on whether my son was low-functioning or high functioning as basis for my future actions. With the changes in the DSM-5, children can now be classified as Level 1, 2 or 3.

The new method of consolidating the diagnosis of Asperger’s syndrome, autism and PDD-NOS into just one diagnosis would eliminate the notion that those with Asperger’s syndrome are better off than those with autism and PDD-NOS. On the other hand, the disadvantage would be if we correlate the parents’ level of hope with the level of functionality defined during assessment. The more a parent knows about the severity of autism in his or her child, the more helpless and distraught they may become. Likewise, the intensity of intervention may also be taken for granted by the parents of higher functioning children.”

(Jane Ann S. Gonzales is a mother of a youth with autism. She is an advocate/core member of the Autism Society Philippines and Directress of the Independent Living Learning Centre (ILLC) Davao, a centre for teenagers and adults with special needs. For comments or questions, please email janeanngonzales@yahoo.com)

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